Trauma Mastery

IMG_0253Note: This is an excerpt from my essay “The Body Remembers” in my book Soul Stories: Voices from the Margins (San Francisco: University of California Medical Humanities Press, 2018).

Early in my career as a nurse, I worked for a year in a “safe house” emergency shelter for women who were escaping intimate partner violence. Before my work there, I did not understand the concept of trauma mastery and how this plays out in the lives of women caught up in the cycle of abuse. I sided with the common misperception that the reason so many women return to their abusive partners is because the women are psychologically damaged and weak.

I learned that there is the not-insignificant role of addiction to the thrill of trauma and danger—to the effects of the very activating yet numbing fight-or-flight neurochemicals—which can bring at least temporary relief to the bouts of fatiguing depression that often accompany trauma. And there are also unconscious attempts to return to the previous trauma to “get it right this time”—to do what we wish we could have done the first time, to master our trauma.

Seattle social worker Laura van Dernoot Lipsky points out that these unconscious attempts to master our traumas often backfire and simply reinforce our old traumas. She says that many of us in health care and other helping professions are often using our work as a form of trauma mastery, and that by doing so, we may set expectations for ourselves and others that are “untenable and destructive.” (1) She advocates ongoing efforts aimed at self-discovery and self-empathy, and points to the many positive examples of “people who have been effective in repairing the world while still in the process of repairing their own hearts.” (2) Eve Ensler, with the combination of personal work and “world repair” work that she describes in her powerful book In the Body of the World, is one of my favorite examples of this sort of balanced approach. (3)

 

Sources:

1 and 2, Laura van Dernoot Lipsky with Connie Burk, Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others (San Francisco: Berrett-Koehler Publishers, 2009), page 159.

3, Eve Ensler, In the Body of the World (New York: Metropolitan Books, 2013).

 

Why Write?

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From the 2017 Northwest Network for Narrative Medicine Conference, Portland, Oregon

Recently, in a writing workshop on social justice issues, I was given a copy of Terry Tempest Williams’ essay “Why I Write” and in response to the reading of that brief essay, was given the writing prompt, Why do you write?

A simple enough (and in some ways too simple, as in a middle school level) writing assignment, but one that I happily took on. Beside my desk at home hangs an excerpt of George Orwell’s 1946 essay, “Why I Write.” In this essay he includes a list of “four great motives for writing” and they include (here in abbreviated form):

  1. “Sheer egoism. Desire to seem clever, to be talked about, to be remembered after death, to get your own back on grownups who snubbed you in childhood, etc., etc.. It is humbug to pretend that this is not a motive, and a strong one.
  2. Esthetic enthusiasm. Perception of beauty in the external world, or, on the other hand, in words and their right arrangement. (…) Desire to share an experience which one feels is valuable and ought not to be missed.
  3. Historical impulse. Desire to see things as they are, to find out true facts and store them up for the use of posterity.
  4. Political purpose—using the word ‘political’ in the widest possible sense. Desire to push the world in a certain direction, to alter other people’s idea of the kind of society that they should strive for.” pp. 312-313 in, A Collection of Essays by George Orwell, London: Harcourt, Inc. 1946.

So here is my prose poem, “Why I Write”:

  1. I write because my fingers are ink-stained. I write because if I don’t, my pen will explode.
  2. I write to make sense of the world. I write to court chaos.
  3. I write until the rivers of my mind run clear. I write until glyphs are superfluous babble-brook praise.
  4. I write unless there are enough reasons not to. I write unless it is unsharable, and then it stays inside, inscribed, worm-tracing scars.
  5. I write journals, research proposals, reports, patient chart notes. I write poems, blog posts, essays, chapters, books, and marginalia.
  6. I write personal mission statements. I write to humanize health care for patients, providers, and communities.
  7. I write my name. I write my different names beneath the kitchen cabinet of my childhood.
  8. I write because I was here. I write because I am here.
  9. I write to remember. I write to forget.
  10. I write. I am a writer.

I opened this post with a reference to the social and environmental justice writing of Terry Tempest Williams. I close with one of my favorite passages of her writing that I stumbled upon this summer. It is from her book An Unspoken Hunger: Stories from the Field (Vintage, 1995). It reminds me of why I write; it reminds me of the importance of women writers in our world:

“As women connected to the earth, we are nurturing and we are fierce, we are wicked and we are sublime. The full range is ours. We hold the moon in our bellies and fire in our hearts. We bleed. We give milk. We are mothers of first words. These words grow. They are our children. They are our stories and our poems.” p. 59

 

 

Find and Defend Our Quiet Places

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Summer 2017 solar eclipse in Seattle.

Summer is an excellent time of year to focus on finding and defending our quiet places—not so much hammock, family reunion, and beach time (although those are important), but quiet places necessary for reflection and evaluation.

Reflection and evaluation are both terms we banter around and oftentimes use lightly and imprecisely. So, turning to the clarifying Oxford English Dictionary:

Reflection; Senses relating to mental activities

a. The action or process of thinking carefully or deeply about a particular subject, typically involving influence from one’s past life and experiences; contemplation, deep or serious thought or consideration, esp. of a spiritual nature.

Evaluation

1. The action of appraising or valuing (goods, etc.); a calculation or statement of value.

But turning to a different source, from Maori community activists Tamati and Veeshayne Patuwai (husband and wife powerhouse duo), I learned that in Maori the terms for evaluation and reflection are combined. Several years ago when I visited them at Mad Ave* in Auckland, New Zealand, they told me that the Maori word for evaluation means, “To go to a still pond, reflect, be still, look closely, and then tell the truth—first, to ourselves and then to others.”

No matter what our work, professions, families, and communities may be, pause a moment to consider how much better we’d all be if we could find and defend our quiet places. And then tell the truth, first to ourselves and then to others.

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*Mad Ave in Auckland, New Zealand has been instrumental in finding creative, asset-based youth and community-building solutions in an area of North Auckland that had received the negative label of “Mad Ave.” They have the terrific tagline “Activating Community Potential by Any Means Necessary.” Here are some photographs of their work that I took in September, 2015. Community wellbeing through haiku, monster makery, stream restoration, music-making, and public art. That suspended metal bird sculpture in the community/town square is an indigenous version of our Western phoenix rising from the ashes.

 

Dear Angry White Man

IMG_5142Dear Angry White Man,

You do not get to have the last word. Even though another white male leader (of an ostensibly social justice-minded weeklong activist writing retreat) handed you the microphone on the last day so you could defend all generic white men from the “trigger words” (your term) of white male privilege. I do realize that you live in the whitest state in our country and in one of the remotest areas of that state (Oregon, in case people don’t know). I do realize that you have a fragile white male ego and that it would be devastating for you to admit that you have in the past and continue to benefit from nothing more than the (socially constructed) pale color of your skin and the fact that you are male. Devastating, because to admit that would be what? Humiliating? Humbling?

You do not get to have the last word. Do you realize how creepy and inappropriate it is to tell us (an otherwise all-female small writing workshop group) that you have “been closely observing us all week”? Especially when there were a significant number of young women emerging writers in our group? I chose to turn my back to you and to literally walk away at both of these times. For me, that was the appropriate choice given the circumstances. I do not regret that choice. What I do regret is ever having participated in praising your bravery in being in an otherwise all-female writing workshop and for (your words) being there “to work on my white male privilege.” I realize now that was a ruse. I regret that I fell for it early on. I do not fall for it now. You were not there to work on it; you were there to assert it even more.

Dear ostensibly social justice-minded activist writing retreat leaders wherever you are:

Please be mindful of who you hand the microphone to. Please be mindful of who walks away (and why). Please be more careful. Please be more skillful and educated in how to facilitate productive and respectful difficult conversations. Our world, and especially our very broken country, needs you to be more mindful, more careful.

 

Homelessness: A Very Wicked Problem

IMG_4766Wicked problem: a term coined by two UC Berkeley professors of urban planning, Horst W.J. Rittel and Melvin M. Webber, to describe difficult social policy issues such as poverty, crime, and homelessness. This is included in their still surprisingly relevant journal article “Dilemmas in a General Theory of Planning” Policy Sciences (4), 1973, pp. 155-169. Rittel and Webber write, “As distinguished from problems in the natural sciences, which are definable and separable and may have solutions that are findable, the problems of governmental planning–and especially those of social or policy planning–are ill-defined; and they rely upon elusive political judgment for resolution. (Not ‘solution.’ Social problems are never solved. At best they are only re-solved–over and over again.)” (p. 160)

That last parenthetical comment is worth repeating until it sinks in. Homelessness as a prime example of a wicked problem will never be solved. The most we can hope for is that it will be re-solved. Our U.S. healthcare system is another example of a wicked problem. Therefore, unless my basic math fails me, health care for the homeless is a wicked problem squared. That does not equate with a reason to give up and not even try to address the wicked problems of homelessness and health care. It means that all of us are called upon to have the resolve to figure this out together.

Having a seemingly never-ending assortment of expert panels and reviews of evidence-based practice aimed at finding solutions for the crisis of homelessness may be necessary, but it will never be sufficient. Having a place-based, grass-roots approach and one that is supportive of critical reflection has greater potential for being more broadly effective. And this isn’t mere consumer or community-member token representation on policy committees as is so often practiced.

“Place oriented inquiry and practice emphasizes bottom-up strategies for the adaptive,
sustainable governance of complex dynamic landscapes. Adopting a spatial or place-based perspective helps with recognition that most knowledge is, to a significant degree, local or context-dependent, as all knowledge-holders occupy—by virtue of their biography, training, and geographic experiences—some particular, delimited position from which to observe the world. Wicked-problem conditions, the argument goes, require the cultivation, transmission, and application of existing bottom-up knowledge held by embedded actors in the landscape.” pp. 18-19.

Source: Weber, P. & Lach, Denise & Steel, S.. New Strategies for Wicked Problems: Science and Solutions in the 21st Century. Corvallis: Oregon State University Press, 2017.

 

Homelessness: Native Seattle

E23611D1-BEFE-4A2D-AC70-C0BD4D09CA1EI offer these images of Seattle Pioneer Square from my Skid Road street hauntings, alongside powerful quotes from Coll Thrush’s important book Native Seattle: Histories from the Crossing Over Place, second edition (Seattle: University of Washington Press, 2007). Even though it is not specifically about homelessness, it is essential reading for a deeper understanding of homelessness in Seattle.

“In 1991, The Seattle Arts Commission launched an ambitious program called In Public, a citywide set of installations designed to inspire dialogue about the role of art in everyday life. (…) In Public was edgy and controversial. One of the most confrontational pieces, by Cheyenne-Arapaho artist Hachivi Edgar Heap of Birds, was installed in Pioneer Place Park alongside the Chief-of-All-Women pole and a bronze bust of Chief Seattle. Called Day/Night, it consisted of two ceramic panels inscribed with dollar signs, crosses, and text in Whulshootseed and English that read ‘Chief Seattle now the streets are your (sic) home. Far away brothers and sisters still remember you.’ Dedicated to the city’s homeless Indians, Day/Night challenged Seattle’s other place-stories.” pp. 173-4.

Note that the images included above are two photographs, a juxtaposition of a “modern” street art image of Chief Seattle from a Pioneer Square alleyway, as well as one panel of Day/Night in English and reads “Chief Seattle now the streets are our home.” The day I took this photograph the second ceramic panel of the Day/Night art installation was not there. Vandalized? Being repaired?

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The second image and quote from Thrush’s Native Seattle have to do with the earliest days of the white American settlers/Pioneers who staked land claims on what is now Seattle’s Pioneer Square—an area that was known as the Little Crossing-Over Place by Chief Seeathl (Seattle). The Little Crossing-Over Place had a source of fresh water and had been an old Indian fishing village. The photograph above is of a Pioneer Square saloon alleyway doorstep (and nighttime sleeping place) located near the Chief Seattle Club, a terrific multi-service agency “providing a sacred space to nurture, affirm and renew the spirit of urban Native people.”

“Indeed, well before the day when Bell, Boren, and Denny decided that Little Crossing-Over Place would be their new home, the indigenous world of the Duwamish, Lakes, and Shilsholes had been irrevocably transformed. The ruined longhouse at Little Crossing-Over Place, overgrown with wild roses (and, according to oral tradition, only one of several that had once stood there), spoke to the abandonment of towns in the wake of epidemics and slave raids. In Whulshootseed, similar words described both houses and human bodies: house posts were limbs, roof beams were spines, walls were skin. Just as sweeping a house and healing a body could be expressed with the same verb, related words spoke of illness and the falling down of a home, and so the ruins were testaments of loss.” p. 38

Below, is a photograph of the native plant, the Nootka Rose, mentioned in the quote above. I took this photograph recently while walking through the University of Washington Botanic Garden’s Union Bay Natural Area— which is built on top of a large Seattle landfill that long ago had been an important Native American fishing village. Thrush concludes his book with these words:

“… in every college diploma earned by an Indian, in the restoration of urban nature and in the willingness to challenge narratives of progress, there is hope that Seattle’s Native past—or, more accurately, its many Native pasts—can be unearthed. These place-stories, linked to urban and Indian presents and futures, will not simply be cautionary tale, smug jokes, or nostalgic fantasies but will be dialogues about the transformations of landscape and power in the city and about strategies for living together humanely in this place.” p. 207

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Homelessness Visible

IMG_4667Our latest point-in-time count of people experiencing “absolute” homelessness in King County tallied 12,112 homeless individuals on January 26th, 2018 (see the All Home King County‘s 2018 report “Count Us In”). By the term “absolute” I refer to the fact that they use the strict HUD definition of homelessness, which excludes the considerable number of people (especially teens and young adults) who are couch-surfing, doubled-up with friends or extended family members and who do not have a safe, stable, affordable place to live. In this respect the HUD definition differs from the official definition of homelessness for healthcare services funded through the U.S. Department of Health and Human Services (see the various definitions compared here by the National Health Care for the Homeless Council).

The 12,112 homeless individuals counted for 2018 represent a 4% increase over the 2017 homeless count (which represented a 19% increase from the 2016 count). Some politicians claim that the slowing percentage increase in people experiencing homelessness can be counted as progress—although as a reality check, the 4% increase in homelessness is much larger than the total population growth for King County. The most recent published statistics show a 2.3% population growth for King County for 2016-17 (source: Washington State Office of Financial Management). As another significant reality check, the homeless count survey methodology changed considerably for 2017 such that comparisons with 2016 numbers should not be made.

Significantly, the 2018 homeless count found that over half (52%) of homeless people were unsheltered the night of the count, with many people living outside in tents and in vehicles. Having participated in the survey this year, I can attest to the difficulty of finding and assessing whether or not parked vehicles are being lived in between the 2-5 a.m. timeframe the day of the count. It is much easier to count the number of people staying overnight at an emergency shelter. And homeless people living in tents tend to find thickly wooded areas in which to live—and not, as in the photograph above, more visibly along well-lit streets and bike paths. But for all of us who live, work, study, and play in Seattle and throughout the rest of King County, we didn’t need the official homeless count to tell us we have a growing problem. We have homelessness, abject poverty and despair, quite visible.

Note: In a series of subsequent posts I will address intriguing, intelligent, and excellent questions which I have received lately about our homelessness crisis. They were too numerous and complex to address in one post.